capa Fo Too a a ars Wa Rae ae Republi of he Pings C= mamas eas re He OFFICE OF THE CIVIL REGISTRAR GENERAL CERTIFICATE OF LIVE BIRTH LEYTE i a Registry No. ‘pany PALO City/Municipality 2024-1374 7, NAME. Tr ‘aiey Tas JASBEER KEN AGULLO CAGABHL-ON’ 2, SEX WalelFamaie) 3. DATE OF Wey ear 7 MALE siRTH MARCH 2024 | | PLAGE OF age g Reiger Pranesy ~ L|_ORTHiScpracmpscnstosounsscemer PA ee D | Se:YPE OF BIRTH [b.1F MULTIPLE BIRTH, CHILD WAS Sc. BIRTH ORDER Gan cima wei J6) WEIGHT AT BIRTH (Single. Twn, Tepe, eto) (ist, Second, Third, et) Bro eb heuer SINGLE NOT APPLICABLE “AIRE 3120 ams 7. WAIDEN Tit asa) Te INANE MENCHIE ESTRELLA ‘AGULLO 10 | FGBiRESN SRBMANPERFEIIUS SECT FT ta-Twnoino1O5 io cen vl] aaa mm OESUERTON [a ROE ai ee JH | eager ae] we sv oven ea [HOUSEWIFE ti ced yeas) = IR [39, RESIDENGE House No, St, Barangay) (Civntoneipai) (Provinesy ‘Coun, Zone Bey. LOAN, putag LevTe PHILIBPINES 7a, WANE wi ‘Taaey K JUNCRI BITUALLA cAGaBI T | 15, CITIZENSHIP 46, RELIGIONIRELIGIOUS SECT | 17. OCCUPATION 18. AGE atthe time ofthis 7, File ROMAN CATHOLIC DRIVER E | 79. RESIDENCE “(Fiouse No, St, Barangay) ‘(Cityitaunicipaityy (Province) R RGY. LUAN, DULAG LeyTE MARRIAGE OF PARENTS (I not manied, accomplish Affdavt of Acnowedgement/Admisson of Petry atthe back) 20a. DATE Worth) (Day) (Wear) [208, PLACE _(CiyrMuncipayy (Province) (Coun | JUNE 23, 2017 DULAG Leyte PHILIPPINES [ia ATTENDANT |X 1 physician 2Nuse 3 Midwife _4 Hilt (Traditional Binh Attendant) __5 Others (Specity) 21b. CERTIFICATION OF ATTENDANT AT BIRTH (Physician. Nurse, Wwe, Teal) Bh Alendanihiok t=) hereby certly that 1 ‘the bith ofthe child who was bom alve a10®:25 PIM amjpm on the date of bith specified above, ‘GOVERNOR BENJAMIN T, ROMUALDEZ GENERAL HOSPTTAL [signature _____ Address _AND SCHISTOSOMIASIS CENTER PALO.LEVIE [Name in Print [Tite or Postion pate__ APRIL 1, 2024 [22. GERTIFIGATION OF INFO? hereby cerity that all infmation supplied ara true and correct to my own knowledge and bei Signature 723. PREPARED BY _| soraure a ‘8. CAGABHI-ON ‘Name in Print _ANELYN J. ABIAR Naren rn = FATHER DATA CONTROLLER | Reistons a __ Te or Poston . "25NE Ti aRGy-LUAN, ae APRIL 4, 2024 ote APR 2008 JO. 24, RECEIVED BY 2 FESSTEREEE FE DE OF THE CIVIL REGISTRAR Signature _ | Signature _ = Name in Print Tite oF Poston ADMINISTRATIVE AIDE-+ eae PRIt-17,-202 REMARKS/ANNOTATIONS (For LGRO/OGRG Use Only) TO BE FILLED-UP AT THE OFFICE OF THE CIVIL REGISTRAR CEPPIPERIEPPPEPESP EF me aye o o o ry = e 2 AE